Healthcare Provider Details

I. General information

NPI: 1316800782
Provider Name (Legal Business Name): HEALTH EVOLVE TECHNOLOGIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 EXECUTIVE CENTER DR STE 106
COLUMBIA SC
29210-8418
US

IV. Provider business mailing address

121 EXECUTIVE CENTER DR STE 106
COLUMBIA SC
29210-8418
US

V. Phone/Fax

Practice location:
  • Phone: 803-268-3700
  • Fax:
Mailing address:
  • Phone: 803-268-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY SMITH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MHA, FACHE
Phone: 803-268-3700